Hospital mortality in decompensated heart failure. A pilot study

Piccirillo, Gianfranco; Moscucci, Federica; Mariani, Marco Valerio; Iorio, Carlo; Fabietti, Marcella; Mastropietri, Fabiola; Crapanzano, Davide; Bertani, Gaetano; Sabatino, Teresa; Zaccagnini, Giulia; Lospinuso, Ilaria; Rossi, Pietro; Magrì, Damiano

doi:10.1016/j.jelectrocard.2020.05.006

Cited by 10 publications

(31 citation statements)

References 22 publications

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“…In conclusion, we confirmed that the last part of repolarization phases was predictive for mortality, 21 in particularly among the severe decompensated CHF patients its ECG markers could be used to stratify the mortality risk. Te mean was not influenced by the presence of permanent atrial fibrillation, therefore the atrial fibrillation did not seem be a limitation for this inexpensive, easily repeatable, transmittable ECG marker.…”

Section: Discussionsupporting

confidence: 73%

“…The second finding was that NT‐pro BNP, left ventricular end diastolic diameter, and Te mean are related to a higher mortality risk in this category of critical patients. In conclusion, the Te mean was confirmed as marker of mortality 19 also in this category of patients, 21 but the novel and original datum was related to a close correlation between Te SD , a marker of repolarization temporal dispersion, and atrial fibrillation (Table 2). At moment, the pathophysiologic basis of these interrelations are unknown; in our opinion, a key role could be played by the increase of left ventricular end‐diastolic pressure in CHF that, certainly, induces an electro‐anatomical (necrosis, fibrosis, hypertrophy, disarray, etc.)…”

Section: Discussionmentioning

confidence: 67%

“…The results induced a prolonged and inhomogeneous ventricular repolarization phase in the time 4–10,12,13,15,18 . Therefore, Te and Te SD should not be only considered mere arrhythmic markers, but also as electrical markers of heart failure decompensation and mortality, 21 as well as NT pro‐BNP is a serum biomarker. In fact, NT‐pro BNP, left ventricular end diastolic diameter, and Te mean were the only three variables with a significant correlation with the mortality risk.…”

Section: Discussionmentioning

confidence: 99%

“…The short period variability of QT 4,5,9,17,18 and T peak ‐ T end (Te) 9,10,13,16,19 intervals were used to evaluate the risk of sudden and non‐sudden mortality in CHF patients and, in the first, milestone study, 20 the QT variability index was used to stratify the chronic heart failure degree. Recently, we reported an increased mortality risk in decompensated CHF patients with very high level of Te and a close correlation between degree of decompensation, expressed as NT‐proBNP, and the standard deviation of Te (Te SD ) 21 . Aim of present study was to evaluate the QT and Te variability, obtained on short period ECG recordings, in decompensated CHF to assess if the permanent atrial fibrillation and temporal ventricular phase dispersion are mutually interrelated.…”

Section: Introductionmentioning

confidence: 97%

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Short‐period temporal repolarization dispersion in subjects with atrial fibrillation and decompensated heart failure

Piccirillo

Moscucci

Bertani

et al. 2021

Pacing Clinical Electrophis

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Background/objectives The association between chronic heart failure (CHF) and permanent atrial fibrillation is very frequent. The repolarization duration was already found predictive for atrial fibrillation. Aim of this study was to evaluate the influence of atrial fibrillation on short period repolarization variables in decompensated CHF patients. Method We used 5 min ECG recordings to assess the mean, standard deviation (SD), and normalized variance (NV) of the following variables: QT end (QTe), QT peak (QTp), and T peak to T end (Te) in 121 decompensated CHF, of whom 40 had permanent atrial fibrillation, too. We reported also the 30‐day mortality. Results QTpSD (p < .01), TeSD (p < .01), QTpVN (p < .01), and TeVN (p < .01) were higher in the atrial fibrillation than among sinus rhythm CHF subjects. Multivariable logistic analysis selected only TeSD (odd ratio, o.r.: 1.32, 95% confidence interval, c.i.: 1.06–1.65, p: .015) associated with atrial fibrillation. A total of 27 patients died during the 30‐days follow‐up (overall mortality rate 22%), 7 (18%), and 20 (25%) respectively in the atrial fibrillation and sinus rhythm patients. Furthermore, the following variables were associated to the morality risk: NT‐pro Brain Natriuretic Peptide (o.r.: 1.00, 95% c.i.: 1.00–1.00, p: .041), left ventricular end diastolic diameter (o.r.: 0.81, 95% c.i.: 0.67–0.96, p: .010), and Te mean (o.r.: 1.04, 95% c.i.: 1.02–1.09, p: .012). Conclusion In decompensated CHF subjects, Te mean seems be associated to mortality and TeSD to the permanent atrial fibrillation. We could hypothesize that, during severe CHF, the multi‐level ionic CHF channel derangement could be critical in influencing these non‐invasive markers. (ClinicalTrials.gov number, NCT04127162).

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Section: Discussionsupporting

confidence: 73%

Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

See 2 more Smart Citations

Short‐period temporal repolarization dispersion in subjects with atrial fibrillation and decompensated heart failure

Piccirillo

Moscucci

Bertani

et al. 2021

Pacing Clinical Electrophis

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“…Several works have proposed other markers related to repolarization variability measured from short-term ECG recordings, such as the variance normalized by the mean of QT end, QT peak or T-peak-to-T-end (Te) intervals, and have evaluated them in CHF populations. In recent studies, the mean and/or standard deviation of Te have been shown to predict 30-day mortality 58 , 59 and mortality in hospital 60 among decompensated CHF patients.…”

Section: Discussionmentioning

confidence: 99%

Periodic repolarization dynamics as predictor of risk for sudden cardiac death in chronic heart failure patients

Palacios

Cygankiewicz

Luna

et al. 2021

Sci Rep

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The two most common modes of death among chronic heart failure (CHF) patients are sudden cardiac death (SCD) and pump failure death (PFD). Periodic repolarization dynamics (PRD) quantifies low-frequency oscillations in the T wave vector of the electrocardiogram (ECG) and has been postulated to reflect sympathetic modulation of ventricular repolarization. This study aims to evaluate the prognostic value of PRD to predict SCD and PFD in a population of CHF patients. 20-min high-resolution (1000 Hz) ECG recordings from 569 CHF patients were analyzed. Patients were divided into two groups, $$\hbox {PRD}^+$$ PRD + and $$\hbox {PRD}^-$$ PRD - , corresponding to PRD values above and below the optimum cutoff point of PRD in the study population. Univariate Cox regression analysis showed that SCD risk in the $$\hbox {PRD}^+$$ PRD + group was double the risk in the $$\hbox {PRD}^-$$ PRD - group [hazard ratio (95% CI) 2.001 (1.127–3.554), $$\hbox {p}<0.05$$ p < 0.05 ]. The combination of PRD with other Holter-based ECG indices, such as turbulence slope (TS) and index of average alternans (IAA), improved SCD prediction by identifying groups of patients at high SCD risk. PFD could be predicted by PRD only when combined with TS [hazard ratio 2.758 (1.572–4.838), $$\hbox {p}<0.001$$ p < 0.001 ]. In conclusion, the combination of PRD with IAA and TS can be used to stratify the risk for SCD and PFD, respectively, in CHF patients.

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QT and Tpeak‐Tend interval variability: Predictive electrical markers of hospital stay length and mortality in acute decompensated heart failure. Preliminary data

Piccirillo

Moscucci

Carnovale

et al. 2022

Clinical Cardiology

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Background As previously reported, an increased repolarization temporal imbalance induces a higher risk of total/cardiovascular mortality. Hypothesis The aim of this study was to assess if the electrocardiographic short period markers of repolarization temporal dispersion could be predictive of the hospital stay length and mortality in patients with acutely decompensated chronic heart failure (CHF). Method Mean, standard deviation (SD), and normalized variance (VN) of QT (QT) and Tpeak‐Tend (Te) were obtained on 5‐min ECG recording in 139 patients hospitalized for acutely decompensated CHF, subgrouping the patients for hospital length of stay (LoS): less or equal 1 week (≤1 W) and those with more than 1 week (>1 W). Results We observed an increase of short‐period repolarization variables (TeSD and TeVN, p < .05), a decrease of blood pressure (p < .05), lower ejection fraction (p < .05), and higher plasma level of biomarkers (NT‐proBNP, p < .001; Troponin, p < .05) in >1 W LoS subjects. 30‐day deceased subjects reported significantly higher levels of QTSD (p < .05), Te mean (p < .001), TeSD (p < .05), QTVN (p < .05) in comparison to the survivors. Multivariable Cox regression analysis reported that TeVN was a risk factor for longer hospital stay (hazard ratio: 1.04, 95% confidence limit: 1.01–1.08, p < .05); whereas, a longer Te mean was associated with higher mortality risk (hazard ratio: 1.02, 95% confidence limit: 1.01–1.03, p < .05). Conclusion A longer hospital stay is considered a clinical surrogate of CHF severity, we confirmed this finding. Therefore, these electrical and simple parameters could be used as noninvasive, transmissible, inexpensive markers of CHF severity and mortality.

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Hospital mortality in decompensated heart failure. A pilot study

Cited by 10 publications

References 22 publications

Short‐period temporal repolarization dispersion in subjects with atrial fibrillation and decompensated heart failure

Short‐period temporal repolarization dispersion in subjects with atrial fibrillation and decompensated heart failure

Periodic repolarization dynamics as predictor of risk for sudden cardiac death in chronic heart failure patients

QT and Tpeak‐Tend interval variability: Predictive electrical markers of hospital stay length and mortality in acute decompensated heart failure. Preliminary data

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